Case Studies

Undertaking an Individual Management Review

Summary

A GP practice was required to complete an Individual Management Review (IMR) following the homicide of a female patient by her husband. The husband subsequently set fire to himself and died of his injuries. The IMR was being undertaken as part of an overall Domestic Homicide Review, which was being led by an independent organisation.

The Issue

The practice was one of a group of four practices, and the responsibility for completing the review was given to a senior administrator. This individual had attended the multi-agency set up meetings and had not made any progress as she was unclear how to undertake an investigation or what the remit was of an IMR in the context of the overall Domestic Homicide Review.

The group of surgeries sought support from NHS England who agreed to commission some external help to provide advice and guidance.

Our Approach

Niche was contacted a few days before Christmas for this urgent piece of work to be completed before the end of January. We allocated a single investigator to work with the client and made contact with the lead individual the week after Christmas. It was important to quickly develop a supportive and directive working relationship with the lead individual. We set out how we could assist them in completing the IMR: describing the investigation process; developing key lines of enquiry; ensuring that factual information is obtained and recorded; capturing softer intelligence from members of staff through interviews; reviewing policies in place and cross referencing actions taken against policies.

The lead individual was of the view that she had neither the skill nor the capacity to complete the IMR, despite the support programme outlined. We liaised with NHS England to determine what flexibility there was in the project budget and agreed a compromise position. The outcome was that we led the investigation with support from the lead individual in arranging interviews with key members of staff, providing clinical records and policies, and taking notes during interviews.
We completed staff interviews which were recorded as formal signed statements, enhanced the basic chronology started by the lead individual and completed the final report within eight working days.

Our Findings

Essential to being able to deliver the project in time was: good communication with the lead individual; and commitment from the staff team to be responsive to tight timescales requiring clinical commitments to be changed at short notice.

We found that although there was no evidence of any suspicions of historic domestic violence within the family unit, the approach to safeguarding and domestic abuse awareness training had not been implemented consistently across the different sites.
It was clear that staff had not considered the cultural impact of the fertility difficulties the couple had experienced over a long period of time. We recommended that the practice reviewed the ethnic origins of the patient population on a regular basis in order to understand different cultural factors that may impact upon the communication of key information between the clinician and patient.
A key benefit to the practice was that the lead individual who had accompanied the Niche consultant to all the interviews, said that she felt more confident about undertaking an internal investigation in the future.